Conference Highlights: AUA 2016 for Surgeons

New research was presented at AUA 2016, the annual meeting of the American Urological Association, from May 6 to 10 in San Diego. The features below highlight some of the studies that emerged from the conference that are relevant to surgery.

Surgery Vs Radiotherapy for Prostate Cancer

Few studies have compared the efficacy of radiotherapy and radical prostatectomy in patients with localized prostate cancer. Researchers conducted a meta-analysis to assess both prostate cancer-specific and overall mortality among this patient population following treatment with radical prostatectomy or radiotherapy. Most of the 19 studies in the meta-analysis—covering nearly 120,000 patients—assessed patients treated with external beam radiotherapy (EBRT), whereas some included those treated with brachytherapy either separately or with the EBRT group. Among 10 studies assessing overall mortality and 15 assessing prostate cancer-specific mortality, results showed that these rates were higher for patients treated with radiotherapy than for those treated with surgery.

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Flow Disruptions & Robotic Surgery Training

Flow disruptions have been empirically linked in previous studies to a higher prevalence of surgical errors. Research has also shown that these disruptions can occur every 5 to 10 minutes, reduce efficiency, increase complications, and indicate where systems of care need improving. Little is known regarding the impact of resident training on flow disruptions and operative time, particularly in robotic surgeries. For a study, flow disruptions were categorized into disruptions in communication, coordination, external factors, equipment, environment, and patient factors among robotic urologic and gynecologic surgeries, approximately half of which involved resident participation. Average operating times were 5.9 hours for cases involving residents and 4.5 hours for non-teaching cases. Teaching cases had more than twice as many flow disruptions as non-teaching cases. The most common disruptions were coordination- and equipment-related, accounting for nearly 60% of all observed flow disruptions.

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Evaluating Post-Urologic Surgery Readmissions

Surgical outcomes and hospital readmission rates are tied to Medicare reimbursement under the Patient Protection and Affordable Care Act. However, clinical predictors of unplanned readmissions following urologic surgery have not been well defined. A multi-institutional multivariate analysis was conducted to assess clinical factors that predict unplanned hospital readmission after major inpatient urologic surgery. The study used 2011 and 2012 data and involved more than 23,000 patients. The overall readmission rate was 5.8%, with ureteral reconstruction (20.6%) and cystectomy (17.5%) registering as the biggest contributors to readmissions. The following factors were the most significant predictors of readmission:

Organ/space infection.

Pulmonary embolism.

DVT.

Return to the operating room.

In addition, laparoscopic and robotic procedures had statistically lower readmission rates than open procedures.

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Acetaminophen Benefits Kidney Surgery Patients

Evidence suggests that many hospitals do not support the use of perioperative intravenous (IV) acetaminophen because it is more expensive than oral acetaminophen or IV ketorolac. For a study, researchers compared length of stay (LOS) and 90-day total expenditures among patients undergoing radical nephrectomy for the management of kidney cancer or renal mass who did or did not receive IV acetaminophen on the day of surgery. Odds for prolonged LOS were 24% lower for patients who received IV acetaminophen when compared with those who did not. Patients receiving IV acetaminophen also had 90-day direct hospital costs that were $452 lower.

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Nutritional Status Affects Abdominal Surgery Outcomes

Prior research has shown that patients with better preoperative nutritional status have fewer complications than those with poor nutritional status. However, this association has yet to be examined in patients undergoing major abdominal surgery. Study investigators assessed factors associated with 30-day postoperative complications among patients who underwent colectomy, cystectomy, and hysterectomy from 2009 to 2013. After adjusting for age, gender, smoking status, and surgical approach, patients with a greater than 10% weight loss 6 months before surgery had higher odds of developing major postoperative complications than those who did not. Patients with below normal BMIs also had a higher risk of developing complications when compared with those who had normal BMIs. Additionally, smokers and patients with moderate or severe hypoalbuminemia were at increased risk for major complications.